The former district manager at Insys Therapeutics was irate. Several doctors were not prescribing enough of the company’s Subsys painkiller, which contains fentanyl, a powerful and addictive opioid.

So the manager, Jonathan Roper, wrote his sales team a pointed email, saying that “we invest a lot of time, money, blood, sweat, and tears on ‘our guys,’ ” — a reference to doctors who were paid to speak to other physicians about the medicine. “We hire only the best of the best to be a part of our speaker bureau and dropping script counts is what we get in return? This is a slap in the face to all of you and is a good indication as to why NONE of you are climbing in the rankings this quarter.”

Last Thursday, Roper and a former Insys sales rep named Fernando Serrano were arrested and charged with violating federal kickback laws. They allegedly ran a scheme between October 2013 and June 2015 in which doctors were paid thousands of dollars to participate in “sham educational programs” designed to boost Subsys prescriptions, according to Preet Bharara, the federal attorney for New York. The email from Roper two years ago was part of the indictment.

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The arrests come amid intensifying controversy over the abuse and misuse of prescription painkillers and the extent to which these are appropriately prescribed. Federal health officials recently released new guidelines urging doctors to restrict their prescribing and some lawmakers want to pressure the Chinese government to toughen its laws to stop the illicit export to the United States.

The problem gained additional notoriety recently when Prince, the celebrated musician, died of an overdose of fentanyl, although it was not clear which form of the drug he was taking.

“Fentanyl is an incredibly dangerous and highly addictive drug that is finding its way into, and destroying, too many lives in our communities,” Bharara said in a statement announcing the arrests. Roper and Serrano, he said, “helped feed this devastating surge of opioid addictions by tapping into another age-old addiction, greed.”

An attorney for Serrano did not immediately return a request for comment. Neither did Insys. Roper could not be reached for comment.

This is not the first time that Insys has been named in connection with illegal activities designed to boost prescriptions for Subsys, which was approved in 2012 to treat cancer pain and generated nearly $330 million in sales last year.

Last February, a former Insys Therapeutics sales rep pleaded guilty to violating federal kickback laws in connection with an alleged scheme to boost sales of the opioid painkiller. And the drug maker is being probed by various federal and state agencies that are examining whether doctors were encouraged to prescribe the drug for unapproved uses.

The indictment, which was filed in federal court in New York, revealed details of how the former employees hoped to boost Subsys prescriptions.

For instance, the company arranged “social gatherings at high-end restaurants in Manhattan” that were supposed to involve teaching doctors about Subsys but did not really involve any education. Doctors were enlisted to speak at these events, but often “lacked an appropriate audience of health care professionals,” according to the indictment. To make them appear legitimate, sign-in sheets were sometimes forged by adding names of doctors who did not attend.

Doctors who wrote numerous prescriptions were rewarded with lucrative speaking fees. In 2014 alone, Insys paid one physician $147,000 and another, $112,000. These were also two of the largest Subsys prescribers in the US that year, writing prescriptions worth more than $3 million and $2 million, respectively. The prescriptions were paid for by both private insurers and Medicare, which spent more than $1 million on them.

Also worth noting: One doctor wrote 300 to 500 prescriptions for the painkiller, but was not an oncologist, according to the indictment.

Serrano and other reps received bonuses based, in large part, on the volume of Subsys prescriptions written by the doctors they were assigned to work with, according to the indictment. Serrano received a $70,000 bonus in the first quarter of 2014, which was the eighth-largest bonus among Insys reps at the time. In the fourth quarter of 2013, his bonus was about $100,000, the fifth-largest among Insys reps.

Dear Ed Silverman,
Thanks for keeping us up to date on Fentanyl spray, doctors who prescribe it, sales reps arrested for running a scheme, and the millions of dollars of prescriptions written by doctors who were bribed.
Sincerely,
2AirplaneCrashesADay
PS There is a very angry Dr. KM on Seth Mnookin’s piece of ” sensationalist whiney consumer journalism,” and Dr. KM is saying Seth’s written concerns are particularly annoying examples of healthcare’s worsening streams of no-wins for physicians and nurses.
If you hear from the doctor, please encourage him to read the court documents accompanying your piece of sensationalist whiney consumer journalism.